Make checks payable to ACT FAST FLORIDA TITLE , LLC

13968 W. Hillsborough Ave.

Tampa, FL 33635

Phone: (813) 925-3074 Fax: (813) 749-8439

ESCROW DEPOSIT

DATE: _______________ AMOUNT: ______________

SELLER(s) NAME: _______________________________________________________

BUYER(s) NAME: _______________________________________________________

PROPERTY ADDRESS: ___________________________________________________

___________________________________________________

LISTING OFFICE: _______________________________________________________

LISTING AGENT: _______________________________________________________

SELLING OFFICE:_______________________________________________________

SELLING AGENT: _______________________________________________________

ESCROW ONLY: _____________ESCROW & CLOSING:_______________________

CLOSING DATE: ________________________________________________________

COPIES FOR: 1.ESCROW DEPT. 2. OFFICE FILE 3. FAX TO AGENT

PLACE CHECK HERE FACE UP

RECEIVED BY:__________________________________________________________